* 1. Are you male or female?

* 2. How old are you?

* 3. Have you been diagnosed? With:

* 4. Which symptoms do you suffer from?

* 5. Please tick all food products which makes your symptoms worse:

* 6. Do your symptoms interfere with your social life (e.g. going out with friends)?

* 7. Do you work?

* 8. Have you ever felt disadvantages because of your symptoms (e.g. when applying for a job, making friends etc..)?

* 9. Which factors trigger your symptoms the most?

* 10. Would you be willing to be contacted again in order to confidentially discuss your condition?

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